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Is It Safe to Preserve Left Atrial Appendage During Maze Procedure?
Kyungsub Song1, Woo Sung Jang2, Namhee Park1
1Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Center, Keimyung University College of Medicine, Daegu, Korea.
Korean Circulation Journal
|August 1, 2023
Summary
Preserving the left atrial appendage (LAA) during maze procedures maintains better left atrial function than occlusion, with similar stroke rates. This finding impacts surgical decisions for patients undergoing atrial fibrillation treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- The left atrial appendage (LAA) plays a role in left atrial (LA) mechanical contraction.
- The impact of LAA occlusion during maze procedures on preventing cerebral infarction is debated.
Purpose of the Study:
- To compare surgical, hemodynamic, and neurologic outcomes of LAA preservation versus occlusion during maze procedures.
- To evaluate the effect of LAA management on LA function and stroke risk.
Main Methods:
- A retrospective study of 252 patients undergoing cryoablation maze procedures from January 2015 to August 2021.
- Propensity score matching (PSM) was used to compare outcomes between LAA preservation (n=53) and occlusion (n=53) groups.
- Exclusion criteria included mechanical prosthesis and LAA thrombus.
Main Results:
- No significant difference in stroke rates or major adverse cardiac events between groups after PSM.
- LAA preservation group showed significantly better LA mechanical contraction at 1-year follow-up (72.7% vs. 48.6%, p=0.04).
- Median follow-up was 44 months, with 3.8% ischemic strokes in the non-occlusion group.
Conclusions:
- LAA preservation during maze procedures leads to superior LA function compared to LAA occlusion.
- Both strategies demonstrated similar safety profiles regarding stroke incidence.
